Apply for free early learning for 2 year olds | London Borough of Barking and Dagenham

Child's details

First name

Last name

Date of birth

Address line 1

Address line 2

Town

Postcode

Gender

Female

Male

Ethnicity

Please describe the child's ethnic background

Select any of the following that apply to the child

Child or sibling with a CAF (common assessment framework)

Child subject to a child protection plan

Child with disability

Child in the care of local authority

Child with medical needs

Child with special education needs

Child with English as an additional language

None of the above

Current childcare provision

Name of childcare provider

Address

Address line 2

Town

Postcode

Further information

Information about your child you feel will help the childcarer when settling in your child

Parent details

First name

Last name

Relationship to the child

Date of birth

National Insurance Number

National Asylum Seeker Service (NASS) reference

Email

We will use your address to keep you informed of your application status. It is your responsibility to safeguard your emails.

Phone

Where did you hear about the programme?

Do you have parental responsibility for this child?

Yes

No

Referrer details

Your full name

Organisation

Your email address

Your telephone number

What is the child’s start date at the nursery? (to be completed only by childcare providers)

How many hours will the child be attending the nursery? (to be completed only by childcare providers)

General Data Protection Regulations

In order for the Early Education and Childcare team to process your application and allocate a childcare place, we will store your personal information securely in accordance to the General Data Protection Regulations.

We may need to share your information with:

our early year’s childcare providers
professionals working with your family

I have read and understood this General Data Protection Regulations statement and consent for my eligibility details to be checked using my NI number.